week 4 lymphoma sarcoma

Question 1

Historical Mantle Fields

Answer 1

treat lymphatics above diaphragm to L4/L5.
Cervical, supraclavicular, infraclavicular, axillary, mediastinal, hilar
May add para-aortic fields, need gap to match at spine or midplane, tattoo inf border of mantle fields
Low energy AP fields, may need higher on PA fields
Supine, akimbo, chin extension maintained for upper and lower for matching

Question 2

Current Mantle Fields

Answer 2

Irradiate only bulky sites or sites that have not completely responded to chemo *ABVD)
Dose ranges in 20-30Gy for non bulky, sometimes 30-36Gy for bulky, but lower doses much more common
Pre chemo PET helpful
Can deliver AP/PA, IMRT, Proton, Breathhold, 4DCT sim

Question 3

Mantle Radiotherapy Fields

Answer 3

Regional-Involved LNs plus atleast 1 adjacent uninvolved region
Involved Field- Involved LNs and its entire nodal region
Involved LN-includes involved LNs before chemo-requires PET

Question 4

Mantle 3D vs IMRT

Answer 4

AP/PA limits low dose to lung and breast, but more dose to heart
IMRT: Spare OARs, low doses are spread all over, developing breasts at high risk for late malignancy, butterfly technique with arc–no laterals=better conformality, limits dose to heart, but plan is streaky
*balance between lung, heart, breast